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Value based pathology

What role will Pathology play in 21st century healthcare? Will Pathologists be needed?

“Listen to your patient, he is telling you the diagnosis,” is one of Osler’s most famous sayings, but in the early 21st century around 70% of all diagnosis are made in the hospital pathology lab. Indeed, it is not just diagnosis that depends on pathology and pathologists, but prognostication and monitoring of the patient’s response to therapy are also dependent on the lab. In a future of ever-increasing sophistication and effectiveness in healthcare, one would thus assume that the expertise of the path lab and the pathologist will be in ever-greater demand.

There is an alternative vision, however, one in which accurate, speedy point-of-care testing, skill shifting to non-medical and non-scientific personnel, accurate diagnostic algorithms, sophisticated image analysis, mobile technology, etc coupled with ever-greater drives to reduce costs and increase efficiency and value, result in increasing emigration of pathological functions out of the lab and into the community. These distributed fragmented functions would almost certainly be provided predominantly by large and small private entities. Pathologists, pathology labs and pathology as a clinical discipline, would largely disappear.

Which of these visions is likely to become real?

Will it be some combination of the above?

Are there yet other models?

Would 2035 look much the same as 2015?

What model(s) is best for the patient and for society?

What is the value of pathology and of pathologists?

Dr Ken Fleming and Professor Chris Price are leading the development of a programme focused on Value Based Pathology and defining the role of the pathologist in 21st Century Healthcare.